Using Machine Learning to Reduce Burden on Infection Control Staff

Surveillance of health care–associated infection (HAI) is the foundation of infection control and one of the first steps in infection prevention. Traditionally, however, surveillance is performed by infection control professionals (ICPs) who manually review patients' records, searching for defined criteria. Such an approach leaves room for subjective interpretation, resulting in low interrater reliability. Moreover, depending on the surveillance method used — for instance, a search based on antimicrobial results — it may have low sensitivity. In Brazil, leaders at Tacchini Hospital and Qualis, a startup that offers infection control advisory and antimicrobial stewardship, have developed a machine-learning–algorithm robot that has been demonstrated to be a reliable tool for identifying patients with HAIs using a semiautomated method. The performance of this infection surveillance assistant (ISA) robot shows optimal sensitivity, specificity, accuracy, and negative predictive values, and the precision (positive predictive value) is acceptable. The ISA robot identified more patients with HAIs than did the infection control manual surveillance reference. The time spent on patient review was also reduced compared with that spent on manual surveillance. The robot detected HAI in one of every two or three patients reviewed in the interface. The years of the Covid-19 pandemic have highlighted the problem of the shortage of health care professionals, including ICPs. Tacchini Hospital and Qualis aim to increase infection control efficiency, enabling these professionals to spend more time on inpatient wards, implementing care bundles, than handling office activities, such as manual surveillance. In this study, the authors describe the implementation of semiautomated surveillance in a single center, but expanding the model for different patient scenarios and multiple centers should be the future for external validation of machine-learning surveillance. Such models have the potential for generalization because they do not depend only on fixed rules for HAI classification, but they can also learn from data sets in different patient population settings. © 2022 Massachusetts Medical Society. All rights reserved.

Persistent allergic respiratory symptoms induced by food allergy: Report of two cases

Case report Dust is a known mixture and carrier of multiple allergens and an epidemiologic study demonstrated the presence of peanut proteins in school cafeterias and classrooms, suggesting that schools may play an important role in exposure to environmental food allergens. While inhalation of food allergens is a known trigger of IgE-mediate acute respiratory reaction as rhinitis and wheezing, little is known about persistent allergic asthma and/or rhinitis induced by chronic inhalation of food allergens. Here we report two cases of teenagers with nuts allergy presenting with persistent respiratory symptoms when exposed to closed and dusty environments. The first case concerns a 12-year-old boy allergic to walnut and hazelnut (specific IgE > 100 and 81.70 kU/l, respectively). For some years he has had a persistent mild asthma, frequent nasal occlusion and rhinorrhea, without any allergic sensitization to aeroallergens. Symptoms occurred exclusively during school period when he required maintenance therapy with inhaled and nasal steroids. He was asymptomatic and did not need any treatment during summer. During the lockdown period due to Covid-19 pandemic, he did not attend school for several months and he was able to discontinue inhaled corticosteroid therapy without recurrence of asthma and rhinitis symptoms. Asthma recurred after he returned to school, but with only mild intermittent symptoms, probably thanks to the use of masks and the frequent airing of the classrooms. On a single occasion he experienced nasal occlusion and rhinorrhea after that a parent had eaten hazelnut cream in the same room where he was. The second case deals with a 17-year-old boy with a history of several food allergies (milk, egg, wheat, banana, nuts, hazelnuts) and mild persistent asthma in absence of sensitization to aeroallergens. He successfully underwent oral desensitization for milk, egg and wheat in previous years. Asthma symptoms improved over the years together with progressive development of oral tolerance to food allergens for which oral immunotherapy had been done. On the other hand, he referred persistence of allergic rhinitis especially during the school year and his symptoms got worse in classroom. Exhaled nitric oxide was quite increased with evidence of eosinophils in nasal smears. In-vitro and in-vivo tests only detected food allergens sensitizations, in particolar to walnuts and hazelnuts (specific IgE were 61.00 and 55.50 kU/l respectively). These two clinical cases suggest that food allergens might be causative agents of allergic persistent asthma and/or rhinitis as aeroallergens do.

An unusual pseudomelanosis in toddlers

An unusual brownish pigmentation of the pelvis and lower limbs in infants which can be easily removed with a towel, to reappear after a few hours was described. The arcane clarifies when a manufacturer of baby cleaning wipes withdrew a lot from the market, holding it responsible for the phenomenon.